SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC
NPI 1114383023
Specialist in Jacksonville, FL

Q: What is Southeast Orthopedic Specialists, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since January 07, 2016

15255 MAX LEGGETT PKWY, 5TH FLOOR, JACKSONVILLE, FL 32218(904) 634-0640(904) 634-0203 Get Directions Write a Review

NPPES record last updated: June 13, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 13, 2023, Sep 27, 2018 (2 updates tracked since 2018).

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About Southeast Orthopedic Specialists, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST ORTHOPEDIC SPECIALISTS, LLC (NPI 1114383023) is a healthcare organization registered as a specialist in Jacksonville, Florida and active in the NPI registry since January 2016. The organization lists Brett Puckett, President, as its authorized official.

NPPES Registry Identity

NPI1114383023

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameSOUTHEAST ORTHOPEDIC SPECIALISTS, LLC

Location Address15255 MAX LEGGETT PKWY, 5TH FLOORJacksonville, FL 32218-7273

Mailing Address6500 Bowden Rd, Suite 103Jacksonville, FL 32216-8070 · (904) 634-0640 · Fax (904) 634-0203

Phone(904) 634-0640

Fax(904) 634-0203

Organization SubpartNo

Authorized OfficialBrett PuckettPresident · (904) 634-0640

Enumeration DateJanuary 7, 2016

Last NPPES UpdateJune 13, 20232 updates tracked since enumeration

NPPES CertifiedJune 13, 2023

✔ NPI 1114383023 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

15255 MAX LEGGETT PKWY, Jacksonville, FL 32218

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL), Florida Blue HMO (a BlueCross BlueShield FL company).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southeast Orthopedic Specialists, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateFloridaEnrollment IDO20160722002500DME · Physician - Orthopedic/Orthopedic SurgeryDue dateJanuary 31, 2027

Source: CMS Revalidation Due Date List, October 2026 release.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TRANSCENDENT MULTISERVICE ASSIST, LLC

Registered Nurse (Registered Nurse First Assistant)

15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218

Duval County (904) 382-1987

DR. SUDHA RANI MUTYALA MD

Student in an Organized Health Care Education/Training Program

15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218

Duval County (904) 383-1000

MARK A LIVECCHI MD

Physical Medicine & Rehabilitation (Brain Injury Medicine)

15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218

Duval County (904) 456-8297

SHEILA COMPTON LCSW

Social Worker (Clinical)

15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218

Duval County (904) 383-1000

SOUTHEAST ORTHOPEDIC SPECIALISTS, INC

Non-Pharmacy Dispensing Site

15255 MAX LEGGETT PKWY, 5TH FLOOR
JACKSONVILLE, FL 32218

Duval County (727) 755-0693

ALFONSO DAVID MORENO GUTIERREZ M.D

Hospitalist

15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218

Duval County (773) 349-5197

DR. ERIN THOR WOLFF M.D.

Physical Medicine & Rehabilitation

15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218

Duval County (904) 456-8001

HAILEY RUTLEDGE PHARMD

Pharmacist

15255 MAX LEGGETT PKWY
JACKSONVILLE, FL 32218

Duval County (904) 244-0411

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeast Orthopedic Specialists, LLC's NPI number?

The NPI number for Southeast Orthopedic Specialists, LLC is 1114383023. It was assigned to this organization in the NPPES registry on January 7, 2016.

Where is Southeast Orthopedic Specialists, LLC located?

Southeast Orthopedic Specialists, LLC is located at 15255 Max Leggett Pkwy 5th Floor, Jacksonville, FL 32218. The listed phone number is (904) 634-0640.

What is Southeast Orthopedic Specialists, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Southeast Orthopedic Specialists, LLC enrolled in Medicare?

Yes. Southeast Orthopedic Specialists, LLC is registered in the Medicare PECOS enrollment system.

When is Southeast Orthopedic Specialists, LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (Florida, Physician - Orthopedic/Orthopedic Surgery) is due for revalidation by January 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

What insurance does Southeast Orthopedic Specialists, LLC accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Southeast Orthopedic Specialists, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southeast Orthopedic Specialists, LLC was last updated on June 13, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.